We interrupt this story for a live update...

A great sunset. You can just make out James on Frosty at the far end of the pasture.

While the pitiful story of a boy hopelessly lost in the ways of horses is fascinating, we need to break away for a moment to more current events.

I got a great ride in on Lola this evening. While we rode in the front pasture, thunder was softly rolling all around us, and thunderclouds were slowly dissipating as the sun's heat started to wane.

I continued with my plan: walking and trotting to warm up. She didn't stumble once. I then approached the cones. I've been very consistently circling the cones in the same way every ride, the same cone clockwise and the other counter-clockwise. We start at a walk, build energy to a trot for a few circles, and then I cue GENTLY for the lead departure I want, while increasing my energy JUST enough to get her to break into the canter. It's been working like a champ.

We did both cones, and hence both directions, about 4-5 times, with about 3-4 circles at the canter each time. She is taking the correct lead just about every time and she is much stronger in the right (direction) lead than she was just several rides ago. She has consistently given me a nice slow canter for a few rides now, so I feel I can safely say, this isn't just a fluke.

Her stop has improved dramatically, and I almost went over the top of her today because I wasn't braced for such a good stop. I was sloppy, and led the stop with my reins instead of my seat and legs, and I damn near cracked my spine and was over her neck before I knew it. I was better after that miscue.

I then got a little ambitious with her, and instead of stopping after circling one of the cones, I led her out of the circle, brought my energy down to get her in a trot, and then led her to the next cone where we would circle in the trot, but then quickly (but still trying for smooth and slow speed) go to the canter. This is all in anticipation of doing figure 8 work with her in the future. Also, I'm building up to eventually asking for a flying lead change when we go from one cone to the next. But that's several rides away. She still needs conditioning and to build strength.

She seems much more relaxed, and may be more affectionate than I thought. She seems to enjoy pats on her neck and soft words. I almost thought I had her completely when she came and watered while I was filling her water bucket, looking at me cautiously but with less apprehension than her usual; but then she later gave me her hind end when I wanted to reach through her stall panel and touch her face. So she's not done playing hard to get just yet. But I sense there's a crack in the veneer....

A story of a boy who wanted a horse....(Part 2)

So here I was with a horse that I wanted to ride, but was woefully ill prepared for anything to do with horses. I didn't know how to properly care for a horse. I didn't know how best to feed them. I knew nothing about vet or hoof care. I mean, I was in the dark. As far as my parents were concerned, they had bought the horse and the rest was up to me. They didn't know anything about horses either.

As it was obvious to everyone in the stables where my horse was boarded that I knew nothing, people began to shower me with advice. Even the greenest of riders knew more than I did, so I got good advice AND bad advice, and I had no way of filtering any of it. I barely knew how to saddle my horse. Somehow, I muddled through, and started riding in the arena that was located on the stable grounds. But Tuffy Danger didn't ride straight. He liked going sideways, and it was a little unnerving. And he just got worse and worse, and started running me into the arena rails, fences, gates, you name it. He would sidepass into things to brush me off, and I was getting pretty beat up in the process. I found out later that side passing was what had unnnerved his previous owner, and she had given him up because he was too dangerous for her to ride.

"Ride him hard. Put some spurs into him. Ride him easy, don't use spurs." Every one had advice and none of it made sense to me. I'd try something, expecting it to work in 15 minutes, and then get frustrated when it didn't. I learned to longe my horse, with the direction of others. But I didn't know what I was doing, and most of my goal was to round pen my horse into a lather with the hopes that he would be too tired to run me into things when I mounted him. But it didn't work.

Pretty soon things went from bad to worse. My horse started to offer little rears in protest when I was riding him. That usually got me off him pretty fast. So then he learned to do bigger rears. I nerved up and rode him anyway, but at this point he was rearing to nearly vertical at the slightest ride! Someone told my mother, and that same someone convinced her that was dangerous, so she agreed to send the horse to a trainer.

So Tuffy Danger went to the trainer, a cowboy trainer. There, he was ridden hard by some pretty tough guys. After about 45 days, they invited me out to ride my new, improved horse. As soon as I saw him, I knew he'd had it rough. He was scarred all over from the hard use of spurs. He had fresh scars barely covered with dried blood, and old scars he must have received shortly after his arrival. I mounted him, and he did seem different. He was very wired but had a great neck rein and would trot and canter effortlessly. But he sure didn't seem calm or at ease. I rode him with the cowboy trainer, and we rode hard through the South Texas brush, and Tuffy Danger jumped cactus and plowed through anything I accidentally steered him into. He didn't offer to rear. My only instructions on the way home were to ride him hard and use the spurs.

It didn't take long until Tuffy Danger was rearing again, even more viciously than before, and it was just a matter of time before he was going to fall over completely and send the saddle horn through my chest.

I admitted defeat, and my father and me loaded him up and took him to the auction. My father had an "I told you" look on his face the whole time. I felt defeated, but I pretty much hated that horse by that time, and when he was rushed into the stock yards, I didn't care if he was sold to ride or for meat. I was just glad to be rid of him.

My first foray into horse ownership had lasted about a year. I had a few good rides on Tuffy Danger, but too few to mention. Most were on the ranch, working a few cows and with some wide open spaces where he couldn't run me into things. My first horse, a 7 year old registered Quarter Horse purchased for $750 dollars in 1985, was gone, and so was my dream of owning a horse and being a horseman. Whatever horsemanship skills I had inherited from my Grandpa Chuy must have been diluted, because I was a failure at this horse thing.

I rode horses on occasion over the years after selling Tuffy Danger, but I was never easy around them. I maybe rode 3 or 4 times over the next 21 years, but thoughts of horse ownership never entered my mind. I figured I had my chance, and horses were for people of different stock.

I graduated high school, and went to Austin for college, and then entered medical school and residency, so horses were nothing but a bad memory for me for a long time. But the longing to ride horses in a good way must have stayed way back in my brain, because events would bring me back to them.

A story of a boy who wanted a horse....(Part 1)

I've been thinking about my first horse experience. I think some of the successes and failures I've had recently have caused me to reflect. It's been a long journey.

When I was about 15 years old, I got the horse bug. I don't remember exactly how or why it started, but it was a raging fever when I did contract the disease. I'd been exposed to horses in one form or another all my life. When I was a kid, my Grandpa Chuy, would rent and sometimes own, various Shetland ponies for me and the other grand-kids to ride. I've got a picture of me with him on top of one of his quarter horses when I was still in diapers. He always had horses, and over the years, I've heard stories about his horse training abilities and exploits. I can't speak first hand about any of this, because he died when I was 9 years old.

But I do remember one Shetland Pony, Milky Way. And I remember being led on him one Easter when I was about 7, with my uncle leading, and Milky Way started bucking. I wasn't afraid and I was staying on fine, but my Uncle Frank was yelling "jump off, jump off!" so I did. I dusted myself off and that was that. I don't remember crying or being more than mildly upset. The adults inspected the saddle and concluded he has a sticker under the saddle that had caused him to buck. With the insight I have today, I doubt that. I think he was just a pastured pony who didn't get much work until we were around and he was showing a little barn sour behavior when he was being led away from his herd. But the explanation was more than adequate for all the grand-kids, and of course, after that we were hyper-vigilant about asking about stickers before ever getting on him again.

I continued to ride horses off and on during my adolescence, and always enjoyed it. So sometime around age 15, I started to hit my mother up for a horse. I knew nothing about horses, other than that I liked to ride them. My father was a city slicker, so he was of no help. But I pestered my mother until she started to ask around. A guy my mother knew told her about a horse that was for sale. It was a 7 year old gelding, registered quarter horse named "Tuffy Danger". He was being sold by a woman that just didn't have the time to ride him. Was I interested?

I told my mother "yes" and we headed down to South Texas to view the horse at a friend's place. I jumped on the horse and rode with the daughter of the man's ranch we were visiting. I had no fear at that age, and I was happy to walk, trot, canter: anything the horse wanted to do. I did notice that he seemed to ride sideways some times, but I didn't know what that meant and didn't care. He was a horse and he could be mine. We bought him on the spot for $750 dollars, not a small sum for a horse in circa 1985. I don't remember how we got him home, but before I knew it, he was being stabled at a place about 5 miles from my house in Corpus Christi, TX, and I had been outfitted with a new saddle, tack, and spurs. I was a horse owner.

I was living the dream...What could go wrong?

Evening ride on Lola..Best yet!

I know I was pushing my luck a bit to try a ride on Lola again this evening. She had done well on the morning trail ride, but I just felt she could do more and we could keep working on her conditioning.

I brought her to the front pasture and warmed her up with walks and trots. Just a quick stumble in the beginning, but none after warm up. I trotted her around the cones and brought the energy up very slowly to get her into the canter. First attempt was 2-3 beats of counter-canter while going to the right, so I brought her back down to the trot and tried again. Success! This time she took the correct lead and she was smooth. What's more, she wasn't running, but was doing the nicest little slow canter. I kept her at it for about 4-5 wide circles, mindful of her stifle and paying attention in case she seemed to be having difficulty. I stopped her, and she gave me a nice stop and then a nice back up.

We went to the next cone and repeated the exercise, but going to the left, her strong side. She went into the correct lead easily and a nice SLOW canter. BUT, she did have trouble sustaining it, and stumbled twice. I took it easy on her, and let her walk it off around the pasture. She seemed OK, so I tried the right circle again. She took it up correctly and stayed with the SLOW canter. No stumbles in this direction, and another 5 or so wide circles.

I kept repeating the exercise, first one way and then the other, and there were no more stumbles and no more incorrect lead departures, and her canter stayed slow and controlled throughout.

Let me explain, I am ALL ABOUT THE CANTER. That's what gives me the greatest joy when riding, and I really like the slow controlled canter. To me, it tells me a lot about the horse's mindset, willingness, and it's the speed I like to use when I need to safely, but quickly, get something done. Who doesn't like the canter, right?

Well, this was the slow canter I've been trying to get for a while from Lola. I didn't enjoy her previous darty, charging canter with no control. This controlled canter is what I like to get from all my horses, and it was getting frustrating that I wasn't getting it from Lola. This day made up for a lot.

I concentrated on being a particularly good rider today. I was using split reins, and Lola seems to work better with them versus the loop rein. Or maybe I was just having a good day with them. I rode with my hands VERY independent from my seat so as to stay "out of the way" of her movements. I also concentrated on "staying out of my stirrups". I wanted to feel like my seat and legs were keeping me very centered and balanced and that there was virtually no pressure from my feet pressing on the stirrups. I wanted it to feel like I was riding bareback. Maybe that helped, because she was very balanced circling in the canter.

After the pasture work, I rode her a ways from the house and worked on going up and down some small hills. All told, I rode her about 30 minutes, but it was a very focused, successful 30 minutes.

I quit on a good note, and she seemed pleased. She even let me rub her head while she was in her stall, something she doesn't let me do too often. I felt we had a real connection out there today. It was a great ride.

Ride with Frank and Tony...

Tony on Woody, Frank on Lola, me on Vaquero

My cousin is in town, and I had a chance to ride with him today. He's the cousin that alerted me to Lola when she became available on Craig's List. He had yet to ride Lola, and had missed riding the trails in my neighborhood by circumstance of weather on his previous visits. He brought his son Tony, so after a nice evening at the Cibolo rodeo nearby the evening prior, we were primed for a Sunday morning trail ride.

Frank rode Lola, and his son Tony rode Woody. I mounted Vaquero. After a warm-up in the front pasture, we hit the trails. We did all three, and by the last mile, Tony was released from the lead rope and allowed to ride solo.

Tony and his Dad mounted and ready to start the trail ride.

At the end of the trail ride, Frank trotted and cantered Lola. I am happy to report her trot and canter for him was easy and controlled. She only stumbled a couple of times during our warm-up session, and not at all late in the trail ride or after, during trotting and cantering.

Frank was very pleased with how she rode, and really liked her height and conformation.

As the morning had warmed up to a hot day, we jumped in the pool after the ride to cool off and spent the rest of the afternoon making BBQ and talking.

Good times.

Victoria rides Lola...

James on Frosty...

It was a nice evening for a little pasture work and a trail ride afterwards. Victoria, my oldest, consented to ride, and so it was a 3 horse adventure. Victoria on Lola, myself on Woody, and James on his 2 year old gelding Frosty.

We started with some simple walking and trotting in the front pasture, in both directions, to get them warmed up. Victoria was all over the saddle, and she needs to ride more to keep her balance and muscles up. Lola stumbled maybe twice, and only in the beginning.

James and I did some relaxed work around the cones, at the trot and then at Woody's slow canter. It really helped Frosty to be following behind, as it rated his speed considerably and made him focus on his circle. We did this in both directions, and James noted that the left lead dominant Frosty was much smoother in the left circle.

I remember when I first got Woody. His previous owner hadn't worried too much about his balance, and he was terrifically left lead dominant as well. By concentrating on cantering on both leads, he became and remains, a very balanced horse in either lead.

Lola and Victoria stayed on the sidelines during our drilling. Victoria hasn't been riding enough for me to be comfortable letting her join in this exercise. But I think I'm going to be encouraging her more strongly this weekend. It's good for her and it really helps me get the horses exercised if she rides.

We finished up our exercises and then hit the trails. Frosty was much more relaxed this ride. Everyone rode well, and we finished with the sun setting and the horses in a light sweat. Honestly, we could have worked them a lot harder, but this was a nice change of pace. And my daughter rode, so that was all I needed for this ride to be memorable.

Victoria on Lola...

Lola's conditioning continues...

Another good ride on Lola, on a very sticky, muggy night. She stumbled about 2-3 times at the start of the ride, but then perked right up. I did a lot of extended trotting. She has a wonderful trot for a quarter-horse, and it requires very little effort to post.

I tried her a little at a straight canter, with the idea that I wouldn't turn her very hard. It was a disaster. But not because of her injury, I don't think. See, she takes off and doesn't want to do anything but haul ass in the canter. I brought in her chin with brute force, to see if that would rate her, and it only achieved minimal success. I gave her her head, and she wanted to just tear around the front pasture. Well, that wasn't going to work, as she was bouncing me all over creation and I felt as if she had little control.

I brought her to a halt and just sat on her thinking. I used that time to call out for James, to let him know when his 2 year old gelding was in the correct lead. "Yes", I'd yell if he was in the correct lead for the circle he was trying to get his inexperienced horse to take. But more often I was yelling "No", to let James know he was in the incorrect lead. His horse is very left lead dominant, and he's trying to balance him. Not much success thus far.

The pause let me see James try to manhandle his gelding and not get very far. After he finally got frustrated, he walked his horse over to me and we sat and talked. "This isn't working for either of us, is it?" I asked. He agreed. I said "Hold my horse", and with that I went into the house and brought out two orange training cones I had bought several weeks back and forgotten to use. "Let's set these out and play follow the leader", I said.

Well, I took Lola and guided her into a big circle around the first cone. Not too tight, so as not to further injure her. I just let her trot her smooth trot in as perfect a WIDE circle I could make with her. She seemed to get the idea, and kept circling at a fast trot. When I had done this about 3 times, we moved to the other cone and circled the opposite direction. At one point, without my asking for it, she broke into the nicest little smooth canter on the correct lead, and she repeated this when we went back to the other cone in the other lead. Now, these were big circles, and I hadn't asked for the canter, but I suspected she would find the canter a lot easier than the fast trot she was trying to maintain, and I guess she agreed, because she did it effortlessly. The whole time, James was following me with Frosty, and when we stopped our horses, he reported a similar positive experience on his horse. And the energy during the exercise was palpably more relaxed for horse and riders. Except for when we first started, and Frosty got close to one of the cones and it spooked him, so he bucked two bucks until James let him calm down.

This is definitely an exercise worth repeating, and it will allow me to let Lola tell ME how much her stifles will take without pushing her too hard.

After the exercise, we embarked on a little trail ride. It was hilarious watching Frosty get spooked at every little thing on the trail. The black line that marks the edge of the roadway was like a chasm. The darker surface of freshly paved asphalt was surely a deep pool of water. The horse silhouette that held the numbers of a street address was the smallest, full figured horse he'd ever seen, and he kept waiting for it to jump out at him. James handled him well, and everyone survived the ride.

I think Lola can work through this "fixed stifle" if I can keep devoting time to riding her. Of course, I've got Woody and Vaquero that are languishing now. I may have to shift to them for the rest of the week. But I am really enjoying Lola's trot and fast walk. We'll see...

The rides with Lola just keep getting better...

I tried to stick with my plan to keep conditioning Lola, so despite being tired and post-call, I got on the riding boots and headed out to catch Lola.

Remember, Lola hasn't always been the easiest horse to catch. But I'd been reading the book Breathe lent me, "Whole Heart, Whole Horse" by Mark Rashid, and I entered the pasture with a little different mind set. I went after catching Lola with absolutely no hurry to my work. I just hung out a bit and approached her slowly. She barely moved. I didn't rush to halter her, but stroked her and let her just be next to me for a while before I haltered her. It was easy as falling off a log. Victoria, my oldest and the one who SHOULD be riding Lola, broke into applause at the easy catch.

The kids mounted their bicycles and I mounted Lola and we headed off to the park. I kept Lola to a walk/trot. She stumbled softly two times, maybe three, at the start, and never stumbled again. We did a few trails, horses and bicycles together, and worked up another light sweat by the end. We spent more time on collection at the trot, and she is holding her flex at the poll with less complaint.

Well, I guess it's working. The "locked stifle" she was having trouble with seems to be responding to more frequent riding. I didn't lope her very much and I think it'll be some time before I work her in the canter significantly, but she is definitely showing improvement in many aspects.

Better ride on Lola...

I had the farrier out on Friday, July 16th. He found no evidence of hoof abscess. I had looked her over carefully for the three days preceding his visit, so it was gratifying to know my exam was consistent with his.

He did suggest a possible diagnosis for Lola's issue, and that will be detailed below. I have placed in bold the symptoms that I think fit Lola's case.

I decided to ride Lola today, as she was showing no signs of lameness while in the field. In fact, I had been watching her trot and canter freely in the pasture for 2 days without a hint of trouble. Upon the first 50 steps of walking out, she was dragging her left toe and stumbling. I kept walking her, and she started to smooth out. After about 5-10 minutes of walking, her clumsiness was gone and she was using her fast walk, a wonderful walk that kept Woody in a slow trot to keep up.

I proceeded to ride her for about 3.5 miles on all three trails in my neighborhood, up and down inclines, at various speeds. Mostly, we stayed in a fast walk, but we did some extended trotting and some bursts of canter, with circling in both directions and in both leads. She never seemed to pull up gimpy. In fact, it was one of the best rides I've ever had on her. I worked on collecting her during the periods of prolonged trotting. She finished with a nice sweat, but not lathered. The temperature dropped as thunderstorms ringed my neighborhood, but it never rained. A rainbow was present throughout the ride. A perfect evening, really.



Upward Pateller Fixation
Intermittent upward patellar fixation is a condition whereby the horse's pelvic limb temporarily "locks" in extension. As a result, there is a delay in flexion of the limb. The delay in flexion can range from milli-seconds to over several minutes. A short delay in flexion may manifest only as a subtle pelvic limb asymmetry or lameness; severely affected horses (with a long delay in flexion) may be unable to flex the affected limb without assistance.

What is the "Patella"? The horse's stifle joint is analogous to the human knee. Just like humans, horses have a patella, or "knee cap", which slides along the distal aspect of the femur (thigh bone) during flexion of the joint. The patella slides within a groove (called the trochlear groove) and serves as a fulcrum for the extensor muscles and their tendons as they course over the front of the stifle (or knee) joint. The patella is attached proximally to the quadriceps and biceps femoris muscles and distally to the tibia. In humans, the patella is attached to the tibia by one distal patellar ligament. Horses have 3 distal patellar ligaments: the medial patellar ligament, the middle patellar ligament, and the lateral patellar ligament.

How does the horse 'lock' the pelvic limb? Horses have the ability to lock (or fixate) the pelvic limb in extension. This is possible due to the unique anatomy associated with the horse's stifle joint. The proximal aspect of the medial femoral trochlea is shaped similar to a hook or ski jump. By placing the space between the medial and middle patellar ligaments over this hook, horses can "lock" their pelvic limbs in extension. Once locked, minimal effort is required to maintain limb extension. A similar locking apparatus in the thoracic limbs allows horses to sleep while standing. Therefore, patellar fixation while standing is a normal process in the horse.

What is 'intermittent upward patellar fixation'? Although patellar fixation is normal in the standing horse, it can produce pelvic limb dysfunction if it occurs during exercise. Inadvertent locking of the patella over the medial femoral trochlea prevents normal flexion of the affected limb(s). Consequently, pelvic limb asymmetry and lameness frequently become evident.

What causes upward patellar fixation? There are 3 primary causes of upward patellar fixation in the horse:

a.. Lack of fitness: Lack of quadriceps and/or biceps femoris muscle tone results in an inability to quickly pull the patella up and off of the medial femoral trochlea.


b.. Straight or upright pelvic limb conformation: This places the medial femoral trochlea further distad in closer proximity with the patella, facilitating patellar fixation.


c.. Excessive distal patellar ligament length: This places the patella proximad in closer proximity with the medial femoral trochlea, where it can inadvertently "catch" or "lock"
It should be noted that the factors which cause upward patellar fixation are often interrelated. For example, an unfit horse will generally have increased laxity (and therefore increased length) of the distal patellar ligaments. Furthermore, if unfitness is secondary to another disease process (such as neurologic disease), intermittent upward fixation may also occur secondarily. Therefore, it is important to assess the horse as a whole prior to determining the cause for upward patellar fixation.

What are the clinical signs? Horses with intermittent upward patellar fixation will exhibit clinical signs during their attempt to flex the pelvic limb from an extended position. In acute severe cases, the pelvic limb may stay locked in extension. The horse may not be able to flex the stifle and tarsus without assistance. In some instances, the condition may temporarily resolve only to recur after taking a few steps. These signs are quite obvious and diagnosis is relatively simple if the condition is severe. Most of the time, however, there is only a "catching" of the patella as it slides up and over the hook and the limb does not truly lock in extension. In this situation, there may only be a mild pelvic limb asymmetry or lameness. This type of lameness can be easily confused with other problems and therefore may present a dilemma in regard to accurate diagnosis. Following are common clinical signs associated with mild to moderate forms of intermittent upward patellar fixation:

a.. Non-weightbearing pelvic limb lameness
a.. This may be distinguished from tarsal (hock) soreness which is usually weightbearing in nature
b.. The horse will frequently drag the toe of the affected limb(s) during exercise
a.. Visible wearing of the dorsal aspect of the toe/shoe may be apparent.
c.. The foot of the affected limb(s) will have a low-arc flight pattern
d.. The horse will usually exhibit a shortened cranial phase to the stride
b.. Resistance in the canter
a.. The horse will resist the canter, particularly if circled toward the more affected limb
b.. Resistance may be most noticeable during the transition between the trot and canter, when the horse is forced to extend the pelvic limb for a prolonged period
c.. Many horses will toss their head, rear, or stop when asked to canter. This may be due to their "anticipation" of impending upward patellar fixation.
d.. The horse would rather trot than canter (which is harder for the normal horse)
c.. Consistent lead changes or cantering on the wrong lead
a.. The horse avoids prolonged pelvic limb extension with the affected limb. This is particularly apparent when cantering in a circle towards the affected limb.
d.. The canter is very rough or "bouncy"
a.. This occurs as a result of consistent delay in pelvic limb flexion from the extended position
e.. Swelling, heat, and/or pain may be associated with one or both stifle joints
a.. Upward patellar fixation causes patellar instability which in turn may result in femoropatellar synovitis
f.. The horse drags his hind toes during exercise
g.. Resistance and/or difficulty when walking up and down hills, or when backing up
a.. These situations force the horse to extend the pelvic limb for a prolonged period
b.. Rather then fully extend the pelvic limb(s), the horse may "crouch" while walking
c.. Rather than flex the pelvic limb(s) normally, horses will often swing their limbs to the outside
d.. This may cause the lameness to be confused with neurologic disease (such as EPM or stringhalt)
h.. Lameness is most severe when the horse is first taken out of the stall
a.. Many horses will improve as the workout progresses
i.. Lameness becomes more obvious following an extended period of stall rest
a.. Loss of muscle and patellar ligament tone exacerbate the upward patellar fixation
b.. The horse does not improve (and may worsen) as a result of taking time off
j.. The horse does not respond to anti-inflammatory (e.g. Phenylbutazone) therapy
a.. Intermittent upward patellar fixation is a mechanical problem and is not inflammatory-mediated
As with many cases of pelvic limb lameness, secondary abnormalities such as thoracolumbar ebaxial (back) and proximal thoracic suspensory ligament soreness are also present. These are generally detected during the passive lameness evaluation and are suggestive of chronic pelvic limb asymmetry/ lameness.

How is upward patellar fixation diagnosed? Clinical signs are characteristic and, if the limb is locked in extension (i.e. the case is severe), diagnosis is simple. As previously mentioned, however, most cases are mild and diagnosis may be more difficult. A detailed history and careful clinical evaluation are essential parts of a proper workup. One helpful diagnostic aid involves placing the horse in one or more situations where prolonged pelvic limb extension is normally required. Such situations include walking up and down hills, the trot-to-canter transition, and backing up. When confronted with these situations, the affected horse will either 1) demonstrate upward patellar fixation by temporarily locking the pelvic limb, or 2) cheat by switching leads, swinging the limbs to the outside, avoiding pelvic limb extension, etc.

Many times, a slight hitch or "catch" is visible as the pelvic limb begins to flex from an extended position. This "catch" is most easily detected by visualizing the point of the hock as the horse picks the limb up to advance it cranially. Infrequently, an audible "snap" or popping sound is also evident during exercise (particularly walking).

In many instances, upward patellar fixation can be produced in affected horses by manually forcing the patella upward and outward. The examiner may actually be able to keep the pelvic limb locked in extension using minimal effort.

Since the problem is usually secondary to conformation and/or level of fitness, it is almost always bilateral. However, affected horses historically exhibit clinical signs in one pelvic limb. It is not until the more affected limb is successfully treated that a problem in the contralateral limb is manifested.

How is upward patellar fixation treated? Currently, there are 5 forms of treatment for intermittent upward patellar fixation:

a.. Exercise: Lack of fitness results in decreased thigh muscle and patellar ligament tone. With decreased supporting muscle and ligament tone, it becomes easier for the patella to lock on the femur and harder for it to replace within the trochlear groove. In subtle cases of upward patellar fixation where conformation is relatively good, increased exercise alone may result in resolution of the problem.
We frequently ask the client to grade the level of their horse's current level of fitness on a scale of 1 to 10 (1=very unfit; 10=extremely fit). We suggest achieving a fitness level of at least 7-8 (if possible) prior to pursuing other forms of treatment. This will rule out unfitness as a major contributor to the problem as well as increase the effect of other therapy.


b.. Corrective Shoeing: Since fixation of the patella occurs when the pelvic limb is extended, prolonging the extension phase of the stride can make "unlocking" more difficult. Alternatively, shortening the amount of time the pelvic limb spends in extension allows the horse to unlock his/her patella before the distal patellar ligaments become excessively tight. Since the conformation of the distal pelvic limb and/or the toe length is intimately related to pelvic limb breakover, the farrier can frequently alleviate the problem via corrective trimming/shoeing. Rolling and/or rockering the toe of the shoe, applying a full (egg-) bar shoe, and/or the use of wedged pads (when needed) are commonly used techniques. In many cases, we are able to help the pelvic limbs break over before intermittent upward patellar fixation occurs.


c.. Hormonal Therapy: The administration of estrogen has shown to prove benefical for some horses exhibiting intermittent upward patellar fixation. The presence of estrogen within the body of the horse may increase tension of various supporting ligaments. These include the collateral, suspensory, cruciate, and distal patellar ligaments. Increasing distal patellar ligament tension helps to relocate the patellar further distad, thereby making upward patellar fixation more difficult. This in turn may alleviate clinical signs.
d.. It should be noted that estrogen is also a powerful behavior modificator in the horse. It is often used for stallions and geldings that are excessively difficult to handle, aggressive towards people or other horses, or overly anxious at shows and other events. Estrogen is very effective at reducing anxiety and resistance as well as improving overall behavior in these horses. Treatment usually consists of 2 injections of estrogen (25mg) in the muscle twice weekly for 4 consecutive weeks, then as needed therafter.

Administration of estrogen to mares usually causes them to exhibit clinical signs of estrus (heat). Since this change in behavior is generally undesirable, we do not recommend its use in mares.


e.. Intraligamentous Infusion of Counterirritant: This form of therapy is usually referred to as "blistering". Blistering involves the inject of an irritative substance into soft tissue(s) in an attempt to create an inflammatory reaction. The irritative substance usually consists of iodine 2% in an almond oil base. This substance can elicit an inflammatory response for up to 30 days depending on the amount used and the location of injection. It is important to remember that fibrosis and scar tissue formation within normal soft tissues will occur as a result of severe inflammation. As you know, scar tissue does not function like normal soft tissue. Therefore, blistering in certain areas may inhibit proper function of associated soft tissue. It is for this reason that The Atlanta Equine Clinic typically does not institute blistering as typical form of treatment for soft tissue problems.

However, in the case of intermittent upward patellar fixation, we gain a biomechanical advantage by replacing normal tissue with scar tissue. The infusion of counterirritant within and around the medial and middle patellar ligaments results in the elicitation of an intense inflammatory reaction by the horse's body. With inflammation, fibrosis and scarring of the patellar ligaments occur. During the scarring process, soft tissues will contract (shorten). As the patellar ligaments shorten, the patella is pulled up and over the hook of the medial femoral trochlea and into its normal position within the trochlear groove. At this point, it becomes more difficult for the horse to lock the patella and easier to flex the pelvic limb from an extended position. In our hands, this from of treatment has been extremely effective in a vast majority of cases involving intermittent upward patellar fixation.


f.. Medial Patellar Desmotomy: The medial patella ligament is one of the key structures (along with the patella and middle patellar ligament) that is required to lock the patella on the femur. Since the problem represents the horse's inability to quickly disengage the patella from the medial femoral trochlea, surgical resection of the medial patellar ligament results in complete resolution of the problem. Once the medial patellar ligament is resected, upward patellar fixation becomes impossible and the clinical signs associated with this condition disappear. Consequently, this has become a very popular form of treatment for horses with intermittent upward patellar fixation.
It is extremely important to note, however, that the medial patellar ligament also performs another function: stabilization of the patella within the trochlear groove of the femur. Without tension from the medial patellar ligament, the patella becomes unstable within the femoropatellar joint. Femoropatellar synovitis and frequently osteoarthritis result. Since the stifle is high-motion in nature, chronic inflammation within this joint poses a significant concern in regard to future performance soundness. Persistent femoropatellar joint inflammation typically needs to be addressed on a continual basis and often requires considerable maintenance therapy. It is for this reason that The Atlanta Equine Clinic views this form of treatment inappropriate except for the most severe of cases that have proven refractory to the other forms of therapy.

Lola is lame...

I rode Lola, the newest addition to my remuda, yesterday. During a previous ride about 2-3 weeks ago, she was stumbling and dragging a rear leg. I gave her some bute and kept her to a walk to complete a trail ride we had embarked on. I put her away and let her rest, hoping things would heal themselves.

Yesterday, she was dragging her left rear leg IMMEDIATELY, even at a walk. I worked her fairly hard, and she kept stumbling and was just terrible through all her gaits, choppy and rough. She was pawing at the ground with her left rear leg and holding it in unusual positions while tied up after the ride. She is OBVIOUSLY hurt. I gave her some bute after the ride, and I'm likely going to visit the vet in a few days. I'm not sure what the problem is, but I'm praying it'll be a quick fix and involve low cost. But you never know with this stuff.

Below are the photos of how she was holding the leg.